comparison between whole body and head and neck

Comparison between Whole Body and Head and Neck Neurovascular Coils for 3T Magnetic

Resonance Proton Resonance Frequency Shift Thermography Guidance in the Head and

Neck Region

Start Time: 9/18/2017, 1:30 PM

Author(s)

Daniel Ginat, MD, MS

Assistant Professor

University of Chicago Medicine

Role: Presenting Author

Greg Anthony, BA

PhD Student

University of Chicago

Role: Author

Gregory Christoforidis, MD

Professor of Radiology and Surgery


Role: Author

Aytekin Oto, MD

Professor of Radiology and Surgery


Role: Author

Leonard Dalag, MD

Resident


Role: Author

Steffen Sammet, DABR, FAMP

Associate Professor of Radiology and Medical Physics


Abstract Details

Purpose:

To compare the image quality of magnetic resonance (MR) treatment-planning images and proton

resonance frequency (PRF) shift thermography images and inform coil selection for MR-guided laser

ablation of tumors in the head and neck region.

Methods:

Laser ablation was performed on an agar phantom and monitored via MR PRF shift thermography

on a 3T scanner, following acquisition of T1-weighted (T1W) planning images. PRF shift

thermography images and T2-weighted (T2W) planning images were also performed in the neck

region of five normal human volunteers. Signal-to-noise ratios (SNR) and temperature uncertainty

were calculated and compared between scans acquired with the whole body coil and a head and

neck neurovascular coil.

Results:

T1W planning images of the agar phantom produced SNRs of 4.0 and 12.2 for the body coil and

head and neck neurovascular coil, respectively. The SNR of the phantom MR thermography

magnitude images obtained using the whole body coil was 14.4 versus 59.6 using the head and

neck coil. The average temperature uncertainty for MR thermography performed on the phantom

with the body coil was 1.1°C versus 0.3°C with head and neck coil. T2W planning images of the

neck in five human volunteers produced SNRs of 28.3 and 91.0 for the body coil and head and neck

coil, respectively. MR thermography magnitude images of the neck in these volunteers obtained

using the whole body coil had a signal-to-noise ratio of 8.3, while the SNR using the head and neck

coil was 16.1. The average temperature uncertainty for MR thermography performed on the

volunteers with the body coil was 2.5°C versus 1.6°C with the head and neck neurovascular coil.

Conclusion:

The whole body coil provides inferior image quality for both basic treatment-planning sequences and

MR PRF shift thermography compared with a neurovascular coil, but may nevertheless be adequate

for clinical purposes.

Comparison of CT-guided core-needle biopsy and fine-needle aspiration in the assessment of

head and neck lesions

Start Time: 9/18/2017, 1:38 PM

Author(s)

Abdul Rahman Tarabishy, MD

Assistant Professor of Radiology

West Virginia University


Matthew David Schmidt, BS

Medical Student

West Virginia University

Abstract Details

BACKGROUND AND PURPOSE: Fine needle aspiration (FNA) and core needle biopsy (CNB) have

both been established as efficient diagnostic tools for image-guided biopsy of head and neck

lesions. FNA has emerged as the preferred diagnostic tool in most situations due to a lower risk of

complications with retained efficacy. If the diagnostic yield of CNB is significantly higher than that of

FNA with a minimal complication risk, CNB should be considered instead of FNA. This study aims to

compare the diagnostic yield of CT-guided FNA and CNB and to support the safety of both biopsy

modalities in head and neck lesions.

MATERIALS AND METHODS:

Retrospective study of 168 patients underwent CT- guided biopsy and the data collected included

age, gender, lesion location, biopsy modality, primary diagnosis applicable to the lesion, pathology

results, and complications.

RESULTS:

The overall diagnostic rates of FNA and CNB biopsy were 60% and 89%, respectively (P < .0001).

CNB demonstrated significantly higher diagnostic yield than FNA for lesions in lymph nodes, parotid

glands, and the parapharyngeal space. CNB was also significantly better at diagnosing new lesions

as well as lesions in patients with known metastatic disease. One complication was noted in a

patient who underwent CNB and developed a moderate neck hematoma requiring overnight

admission.

CONCLUSIONS: CNB carries a very low complication rate and superior to FNA in obtaining

diagnostic samples in head and neck lesions.

Differential diagnosis of odontogenic lesions based on the imaging characteristics of

gubernaculum tracts

Start Time: 9/18/2017, 1:46 PM

Author(s)

Masafumi Oda, DDS, PhD

Research Scholar of Radiology, Assistant professor of Oral and maxillofacial Radiology

Boston University School of Medicine, Kyushu Dental University


Keita Onoue, MD

Radiology Resident

Boston Medical Center

Role: Author

Margaret N. Chapman, MD

Neuroradiologist, Assistant Professor of Radiology

Boston Medical Center, Boston University School of Medicine

Role: Author

Tatsurou Tanaka, DDS, PhD

Associate professor of Oral and maxillofacial Radiology

Kyushu Dental University

Role: Author

Yasuhiro Morimoto, DDS, PhD

Professor of Oral and maxillofacial Radiology

Kyushu Dental University

Role: Author

Osamu Sakai, MD, PhD

Chief of Neuroradiology, Professor of Radiology, Otolaryngology-Head and Neck Surgery, and

Radiation Oncology


Abstract Details

Purpose:

The gubernaculum tract (GT) is a canal that contains the gubernacular cord and/or gubernaculum

dentis (GD). The fibrous GT band connects the pericoronal follicular tissue of a tooth with the

overlying gingiva. Recent pathological and imaging studies have suggested that the GD is one of the

origins of odontogenic lesions and that some odontogenic lesions have GTs that can be visualized

on CT. We hypothesized that the imaging characteristics of GTs might be useful to diagnose

odontogenic tumors or cysts. The purpose of this study was to investigate imaging characteristics of

GTs and to determine its usefulness in diagnosing odontogenic tumors and cysts.

Material and Methods:

This retrospective study was approved by our IRB. 253 patients who underwent MDCT with

pathologically proven ameloblastomas (n=20), keratocystic odontogenic tumors (KCOTs) (n=50),

and dentigerous cysts (n=183) were enrolled. The relationship between the lesion and GT was

divided into three groups based on CT findings; Group 1: GT clearly identified as a tunnel like

structure, Group 2: bone defect at the top of the alveolar ridge (which is likely an expanded GT), and

Group 3: no GT or osseous opening at the top of the alveolar ridge identified. The correlation

between the size of the lesion, the long axis of the bone defect of the alveolar ridge including GT,

and ages of patients were assessed.

Results:

The majority of the lesions were categorized as Group1 (83.1% of dentigerous cysts and 68% of

KCOTs) and Group2 (70% of ameloblastomas). The size of the bone defect at the top of the alveolar

ridge was strongly correlated with the size of the lesion in ameloblastomas (r=0.741, p=0.0001) and

very weakly correlated in dentigerous cysts (r=0.167, p=0.028). No correlation was found in KCOTs

(r=-0.089, p=0.557). When limited to Group 2, there was a strong correlation between the bone

defect size and the lesion size in ameloblastomas (r=0.733, p=0.003) and dentigerous cysts

(r=0.759, p=0.000). Positive correlation was seen between the patient’s age and the bone defect

size of the alveolar defect in dentigerous cysts (r=0.346, p=0.000), while negative correlation was

seen with KCOTs (r=-0.462, p=0.006). No significant correlation was found in ameloblastomas (r=-

0.489, p=0.403).

Conclusion:

Evaluation of the relationship between lesion pathology and GT and size of the alveolar bone

defect/lesion with GT is useful for differentiating amongst certain odontogenic lesions.

Dental Caries on CT in the ER Population: Prevalence and Reporting Practices

Start Time: 9/18/2017, 1:54 PM

Author(s)

Jesse T. Brandfass, MD

Resident

UVM Medical Center


Michael Bazylewicz, MD

Attending Radiologist

UVM Medical Center

Role: Author

Joshua Nickerson, MD

Assistant Professor

University of Vermont Medical Center

Abstract Details

Purpose:

Dental caries can lead to a variety of complications, including odontogenic abscess and odontogenic

sinusitis. In addition, untreated dental caries can cause dental pain and sensitivity, negatively

affecting quality of life. Dental caries can easily be treated. However, many people do not visit a

dentist on a routine basis. Most dental caries are easily identifiable on CT scans that include the

teeth. The hypothesis of this study is that the prevalence of dental caries in the ER population is high

and that caries are routinely under-reported on the CT scans of the face and neck. The purpose of

this study is to measure the prevalence of dental caries in ER patients undergoing CT of the face or

neck and based on the results as well as input from dental professionals provide a recommendation

for radiology reporting practices.

Materials/ Methods:

Retrospective analysis was performed on 200 patients greater than 18 years old who underwent a

CT of the facial bones or neck, with or without contrast between January 1, 2015 and June 30, 2015

at a level 1 trauma center. CT images were reviewed by a neuroradiologist for presence of untreated

dental caries. The radiology reports were reviewed to evaluate the frequency with which dental

caries were included in the report when present. The number of patients with prior dental fillings

resulting in artifact was recorded. Statistical Package for the Social Sciences (SPSS) software was

used for statistical analysis. Faculty of an affiliate dental school was consulted for guidelines for

follow up recommendations.

Results:

A total of 200 CT facial bone or neck examinations were retrospectively evaluated which including

4815 teeth. 75% of patients had undergone previous dental intervention resulting in some degree of

artifact. Despite the presence of at least some artifact in many of the scans, a total of 552 dental

caries were found. Average number of dental caries was 2.76 per person, or 0.11 per tooth. 29.4%

of caries involved the enamel, 49.3% extended into the dentin, and 21.2% extended into the pulp.

53% of patients had at least 1 dental caries, 39.5% of patients had at least 1 dental caries into the

dentin, and 16% of patient had at least one dental caries into the pulp. When dental caries were

present, 12.3% of radiology reports included caries anywhere in the report, and 7.6% included

mention in the impression. The dental professionals consulted for this study recommended a visit to

a dentist within 6 months for caries in the enamel or dentin and a visit to the dentist within 3 months

for caries into the pulp.

Conclusions:

Dental caries are commonly identified on CT examinations of the face and neck, but are infrequently

included in radiologist reports. Given the impact of dental care on overall health and quality of life

and the ability of dentists to treat dental caries, these findings should be included in the radiology

report. A recommendation for outpatient evaluation by a dentist can be made based on the type of

dental caries.

Computed Tomography of the Head and Neck Region for Tumor Staging - Comparison of

Dual Source Dual Energy and Low kV Single Energy Acquisitions.

Start Time: 9/18/2017, 2:02 PM

Author(s)

Wolfgang Wuest

consultant

University of Erlangen


Marco Wiesmueller

doctor


Role: Author

Rafael Heiss

doctor


Role: Author

Michael Brand

consultant


Role: Author

Michael Uder

head of department


Role: Author

Matthias May

consultant


Abstract Details

Purpose:

Aim of this study was to intra-individually compare the image quality obtained by dual source dual

energy (DSDE) CT examinations and different virtual monoenergetic reconstructions to a low single

energy (SE) scan.

Materials and Methods:

Third generation DSDE-CT was performed in 49 patients with histologically proven malignant

disease of the head and neck region. Weighted average images (WAI) and virtual monoenergetic

images (VMI) for low (40 and 60 keV) and high (120 and 190 keV) energies were reconstructed. A

second scan aligned to the jaw, covering the oral cavity, was performed for every patient to reduce

artifacts caused by dental hardware using a SE-CT protocol with 70 kV tube voltages and matching

radiation dose settings. Objective image quality was evaluated by calculating contrast to noise ratios

(CNR). Subjective image quality was evaluated by experienced radiologists.

Results:

Highest CNR for vessel and tumor attenuation were obtained in 40 keV VMI (all p < 0.05).

Comparable objective results were found in 60 keV VMI, WAI and the 70 kV SE examinations.

Overall subjective image quality was also highest for 40 keV, but differences to 60 keV VMI, WAI

and 70kV SE were non-significant (all p>0.05). High keV VMI reduce metal artifacts with only limited

diagnostic impact because of insufficiency in case of severe dental hardware. CTDIvol did not differ

significantly between both examination protocols (DSDE: 18.6 mGy; 70 kV SE: 19.4 mGy; p= 0.10).

Conclusion:

High overall image quality for tumor delineation in head and neck imaging were obtained with 40 keV

VMI. However, 70 kV SE examinations are an alternative and modified projections aligned to the jaw

are recommended in case of severe artifacts caused by dental hardware.

https://www.conferenceabstracts.com/uploads/cfp2/attachments/VAPAYMCZ/VAPAYMCZ--334745-1-IMG.jpg

Dual energy staging CT of the neck – Comparison between Single Source and Dual Source

techniques

Start Time: 9/18/2017, 2:10 PM

Author(s)

Wolfgang Wuest

consultant



Rafael Heiss

doctor


Role: Author

Michael Brand

consultant


Role: Author

Marco Wiesmueller

doctor


Role: Author

Michael Uder

head of department


Role: Author

Matthias May

consultant


Abstract Details

Purpose:

Aim of this study was to compare the image quality of third generation split filter single source dual

energy (SSDE) and third generation dual source dual energy (DSDE) computed tomography for

staging in the head and neck region.

Materials and Methods:

A total of 102 patients were randomized to two study groups: 51 patients were examined on a third

generation SSDE scanner equipped with the split filter technique and 51 patients were examined on

a third generation DSDE system from the same vendor. All patients had histologically proven

malignant disease of the head and neck region. Inline weighted average images (WAI) and offline

virtual monoenergetic images (VMI) at different energy levels (40, 60, 120 and 190 keV) were

reconstructed for image evaluation. Objective image quality was assessed by calculating dose

normalized contrast to noise ratios (CNRD). Subjective image quality was rated on a 5-point Likert-

scale.

Results:

Highest CNRD for vessel and tumor attenuation were obtained at 40 keV in both groups. The vessel

CNRD of DSDE was substantially higher on the WAI (+58%, both p < 0.05) and at low keV levels (40

keV +38%, 60 keV +42%) though not significant for the carotid arteries. CNRD for tumor attenuation

was significantly higher on DSDE-WAI (+45%, p=0.006), but comparable to the VMI. Best overall

subjective image quality was found on the WAI in both groups, followed by 40 keV and 60 keV.

Ratings for diagnostic image quality and image artifacts were significantly better in all

reconstructions from DSDE compared to SSDE, but subjective tumor delineation was comparable .

Conclusion:

Inline reconstructions from DSDE are superior to SSDE in terms of CNRD, overall subjective image

quality and artifacts, but comparable to SSDE for tumor attenuation and delineation.

Evaluation of the submental and submandibular spaces following the submandibular gland

transfer procedure: recognition of the transferred gland and avoidance of potential pitfalls

Start Time: 9/18/2017, 2:18 PM

Author(s)

Xin Wu, MD

Clinical Instructor

University of California San Francisco


Patrick Ha, MD

Professor


Role: Author

Chase Heaton, MD

Assistant Professor


Role: Author

Sue S. Yom, MD, PhD

Associate Professor


Role: Author

Christine M. Glastonbury, MBBS

Professor


Abstract Details

Purpose:

The Seikaly-Jha submandibular transfer procedure, wherein the submandibular gland (SMG) is

repositioned surgically into the submental space, has been used in order to facilitate gland shielding

during radiation therapy for head and neck tumors and in turn circumvent radiation-induced

xerostomia. This procedure results in an asymmetric postsurgical appearance of the submandibular

and submental spaces that, to our knowledge, has not been previously described. The purpose of

this study is to characterize the morphologic and enhancement characteristics of the transferred

SMG relative to the contralateral gland, and to identify potential pitfalls in postoperative radiologic

interpretation.

Materials & Methods:

This IRB-approved, HIPPA compliant study reviewed surgical records from our institution to identify

head and neck cancer patients who had undergone the SMG transfer procedure. A chart review was

performed in order to identify the patient’s primary site of disease and pathology, dates of surgical

and radiation treatment, and postoperative imaging. Neck CT and MR examinations were reviewed

to characterize morphologic as well as enhancement characteristics of the SMGs and key

surrounding structures. Radiology reports were reviewed.

Results:

11 patients with head and neck cancer who had undergone the submandibular transfer procedure

were identified. The primary disease sites included tonsillar, base of tongue, and nasopharynx. All

patients had pre-operative CT imaging. Postoperatively, 9 patients underwent contrast enhanced

MRI imaging, and 6 patients underwent contrast enhanced CT imaging.

The preoperative enhancement and morphologic characteristics are similar between the SMGs, as

defined by anteroposterior length and locations of the anteroinferior, posterior, and superior margins.

Postoperatively, the transferred SMGs are lengthened in the anteroposterior dimension compared to

the contralateral glands. The transferred SMGs are located further anteriorly and inferiorly within the

submandibular and submental spaces. In all but one case, the SMG was transferred into the

subcutaneous tissues superficial to the anterior bellies of the digastric muscle.

In two MRIs acquired less than one month postoperatively, the transferred SMGs demonstrated

>20% increased enhancement compared to the contralateral glands. Asymmetric T2 hyperintensity

is seen in the platysma musculature adjacent to the transferred SMG only in cases performed within

the first four months.

SMG transfer was either provided as a part of clinical history or acknowledged in the report in 7/11

cases. In one case, clinical history of SMG transfer was acknowledged, but the report incorrectly

noted that the transferred gland “was not visualized.” In another case, history of SMG transfer was

neither provided nor acknowledged, and the superior aspect of the contralateral SMG was

incorrectly interpreted as a parapharyngeal mass.

Conclusion:

After a submandibular transfer procedure, the submandibular and submental spaces lose their

symmetric morphology as the transferred SMGs are located more anteriorly and inferiorly.

Asymmetric postoperative enhancement of the transferred SMGs appears to resolve within the first

two months, although edema within the plastyma muscle can be seen up to four months

postoperatively. Familiarity with the postsurgical appearance of the transferred SMG is important in

order to correctly interpret postoperative neck imaging.

Fig1. Axial and Coronal postcontrast T1WI demonstrate submental location of the transferred SMG.

https://www.conferenceabstracts.com/uploads/cfp2/attachments/VAPAYMCZ/VAPAYMCZ--304535-1-IMG.jpg

Ameloblastomas in the maxillofacial region.; CT and MR findings.

Start Time: 9/18/2017, 2:26 PM

Author(s)

Yusuke Kawashima, D.D.S., Ph.D.

Assistant professor

Department of Radiology, Nihon University School of Dentistry at Matsudo


Osamu Sakai, M.D., Ph.D.

Professor of Radiology and Otolaryngology- Head and Neck Surgery Section Head, Neuroradiology;

Director of Head and Neck Imaging

Departments of Radiology, Radiation Oncology, and Otolaryngology-Head and Neck Surgery,


Role: Author

Suemitsu Masaaki, D.D.S., Ph.D.

Assistant professor

Department of Oral Pathology, Nihon University School of Dentistry at Matsudo

Role: Author

Kayo Kuyama, D.D.S., Ph.D.

professor

Department of Oral Pathology, Nihon Univerisity School of Dentistry at Matsudo

Role: Author

Hugh D. Curtin, M.D.

Professor of Radiology

Massachusetts General Hospital

Role: Author

Takashi Kaneda, D.D.S., Ph.D.

Professor of Radiology

Department of Radiology, Nihon University School of Dentistry at Matsudo

Abstract Details

Backgrounds:

Ameloblastoma is a benign but locally invasive polymorphic neoplasm consisting of proliferating

odontogenic epithelium, which usually has a follicular or plexiform pattern lying in a fibrous stroma. It

is the most common odontogenic tumor, and accounts for 1% of tumors and cysts of the jaw and

10% of odontogenic tumors. It is found with about equal frequency in male and female and has the

peak incidence in the third and fourth decades of life. 80% are seen in the mandible and the

remaining in the maxilla. Radiographically, ameloblastomas may show considerable variation

reflecting their polymorphic features. The typical radiographic finding is of a multilocular destruction

of bone, but unilocular ameloblastomas also occur. CT and MR findings of ameloblastomas in the

maxillofacial region have not been fully described in the literature. The purpose of this study was to

evaluate CT and MR imaging characteristics of ameloblastomas.

Methods:

This study was approved by our institutional review board. A retrospective review of our imaging

data base was performed to identify patients with pathologically proven ameloblastoma who

underwent CT or MR imaging between April 2006 and April 2017. The location, margin, bone

expansion, tooth resorption signal intensity of the solid and cystic components, enhancement of the

solid components were recorded. The margins of the lesions were classified as either well- or ill-

defined.

Results:

Fifty-five patients with pathologically proven ameloblastomas (34 males and 21 females; mean age

43.2years; age range 14 to 71 years) were identified. Twenty-nine patents had both CT and MR

imaging, and 26 patients had CT only. Contrast-enhanced MR imaging was performed in 13

patients.

Forty-four patients had mandibular lesions and 11 patients had maxillary lesions. Of the 44

mandibular lesions, 10 lesions were seen in the mandibular body to ramus. Of the 11 maxillary

lesions, 4 lesions were in the maxillary body. Twenty-three lesions showed well-defined margins.

Twenty-seven showed tooth resorption. Twenty-one showed bone expansion at the buccal side. The

solid components showed low signal intensity on both T1 and T2-weighted images in 23 lesions. The

cystic components showed low signal intensity on T1-weighted images and high signal intensity on

T2-weighted images in 29 lesions. The solid components showed marked enhancement in 15

lesions.

Conclusion:

CT and MR findings of ameloblastomas in the maxillofacial region were reviewed. These findings

may be helpful to narrow the differential diagnosis of odontogenic tumors arising in the maxillofacial

region.

Value of ED MR in the Evaluation of Optic Neuritis

Start Time: 9/18/2017, 2:34 PM

Author(s)

Jina Pakpoor, MD MA

Research Fellow

Johns Hopkins University


Deanna Saylor, MD MHS

Assistant Professor of Neurology

Johns Hopkins Medical Institutions

Role: Author

Izlem Izbudak, MD

Assistant Professor

Department of Radiology, Johns Hopkins Medical Institutions

Role: Author

Li Liu, PhD

Assistant Professor

Department of Radiology, Johns Hopkins Hospital

Role: Author

Ellen Mowry, MD

Associate Professor of Neurology,

Department of Neurology, Johns Hopkins Hospital

Role: Author

David Yousem, MD MBA

Director of Neuroradiology, Vice Chairman of Radiology, Professor of Radiology and Radiological

Science

Johns Hopkins Medical Institutions

Abstract Details

Purpose:

The indications for use of MR in the Emergency Department (ED) are evolving. Visual loss is the

chief complaint for over 3.5 million ED visits per year, and acute visual symptoms are notably

unspecific. When a patient presents with visual symptoms indicative of optic neuritis, imaging may

be ordered for confirmation or for identifying other serious disease processes such as multiple

sclerosis or neuromyelitis optica. We sought to determine the value of ED MRI in this setting. Prior to

ED MR these patients would have been admitted for utilization of the inpatient MRI scanner at our

institution.

Methods:

The electronic medical records (EMRs) were reviewed for all ED patient encounters during a two-

year period (3/1/2014-3/1/2016) that utilized the ED MRI scanner and for whom the radiologist

identified optic nerve enhancement/hypersensitivity and/or suggested a diagnosis of optic neuritis.

Patients without a preceding diagnosis of optic neuritis or a demyelinating disease were looked at

separately to those with a preceding multiple sclerosis diagnosis. Details surrounding patient

disposition, final diagnosis and management were determined.

Results:

There were 37 patient encounters for whom optic neuritis or findings indicative of optic neuritis were

suggested by the radiologist based on ED-MR findings. For all cases the indication for the study was

to evaluate visual disturbances and or/pain suspicious of optic neuritis/demyelinating disorders.

36/37 encounters were diagnosed with optic neuritis, and follow-up showed that 10 cases were

further diagnosed with multiple sclerosis and two with neuromyelitis optica.

There were seven patients who had a preceding diagnosis of MS for whom the radiologist suggested

neuritis/enhancement/evolving hyperintensity of the optic nerve. Six were diagnosed with optic

neuritis and admitted for commencement of IV steroids, and one was not.

Conclusions:

ED-MRI provides value in confirming optic neuritis, suggesting multiple sclerosis, and directing

inpatient versus outpatient treatment prior to hospital admission. Evidence has demonstrated that

rapid administration of intravenous steroids to patients with optic neuritis leads to faster recovery of

vision and reduced conversion to multiple sclerosis relative to oral steroids or placebo. Further,

where optic neuritis is ruled out in the ED, patients may avoid needless hospital admission, a

potentially notable financial and resource cost saving.

comparison between whole body and head and neck

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